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SOC364H1 (40)


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Brent Berry

WK 4 1  Traditionally, health research has focused on individual level antecedents  Emphasis on genes, biology, behaviours  Medical model  Neoliberal approach  Recent attention to social causes  Social model  Collectivist  Main contributor to paradigm shift  Socioeconomic health association  Association between income and mortality  Study of obelisks  Cost of the obelisk determined by its height  Better socioeconomic status, indexed by taller obelisks, was associated with great longevity during 1801-1920 Fatality rate for women passengers on the Titanic  1 class 3% 2,class 17% 3,class 45%  How do we explain the socioeconomic health association  George Kaplan 1999 Downstream - Concerned with individual - Focus on changing behavior, ensuring access to care, monitoring quality of care, and identifying health risk factors Upstream - Understanding that social, economic, and environmental inequity are the root cause of health inequity, and that improving social, economic and environment conditions will improve health  Downstream determinants of health  Which includes physiological and biological factors  Features of the individual  Individual level antecedents  Can biological factors explain the socioeconomic health association?  Medical model assumes yes Allostatic load  Low status individuals greater exposure and vulnerability to allostatic load Exposure  Poor working conditions, family problems, economic hardship, discrimination, unequal access to resources, poor living conditions Vulnerability WK 4 2  Inability to cope, less resources(financial, social, psychological) Gene-envionment interactions  The context interacts with the individual’s attributes  Combination of individual and context-level antecedents Behavioural factor and ESE health association  Eating habits, smoking, drinking, coping patterns  Clear association between class and behaviour  Socioeconomic-health association not ONLY a product of behaviour, no obvious relationship between behaviour and SES health association.  Upstream determinants of health  Including education, employment, income, living and working conditions  Features of the environment or broader social situation  Contextual level antecedents Communities and neighbourhoods  Multiple, complex influences  Residents in disadvantage and disorderly neighbourhoods have worse health for a variety of reasons. Social and economic policy  Often the factors influencing communities exist outside the community  Allocation of resources, infrastructure, segregation, subsidized housing  Initiative for equality Moving to opportunity study (MTO)  Randomized housing mobility experiment sponsored by the US dept of Housing and Urban development  4600 low income families with children living in public housing within some of the nation’s most disadvantaged urban neighborhoods the chance to move to private-market housing in much less distressed communities.  Randomly assigned Results for adults  Improved physical health: love prevalence of severe obesity and diabetes  Improved mental health: depression and distress Results for youth  No effect on physical health  Improved mental health for females but not for males: lower prevalence of distress, mood disorders, panic attacks, and oppositional defiant disorder and fewer serious emotional or behavioral difficulties. Methodological approaches  Observe patterns across time and context  Assume, however, only changing factor is context WK 4 3  Cross-national studies suppress patterns of inequality  Multi-level modeling  Statistical approach to examining different ex
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